Critchley Julia A, Capewell Simon
Department of Public Health, University of Liverpool, L69 3GB, UK.
J Cardiovasc Risk. 2003 Apr;10(2):111-9. doi: 10.1097/01.hjr.0000060836.46105.ae.
Prospective cohort studies have made enormous contributions to our understanding of coronary heart disease (CHD) epidemiology in the UK. However, identification of cohorts and dissemination of key characteristics and results can be haphazard, and it is difficult to identify studies which are at the planning stage.
We carried out a systematic review of cohort studies by searching MEDLINE and relevant websites and consulting key individuals. We included all large prospective UK cohort studies that focused on the development of CHD in predominantly healthy subjects.
The MEDLINE search retrieved 1558 hits and we identified 39 cohorts that met inclusion criteria. 'Early' cohorts were important in defining the major risk factors for CHD, particularly smoking, cholesterol, blood pressure, physical activity and body mass index. Prospective cohort studies have subsequently appraised potentially important novel risk factors including nutritional status, genetic determinants, haemostatic factors, lipid sub-fractions, psychosocial factors and the 'life course' perspective. Psychosocial factors have been relatively neglected, as have women, ethnic minorities and the elderly. Key methodological issues include minimizing losses to follow up, standardized measurements, quality assurance systems, change in risk factors over time, residual confounding, regression dilution bias, detection of non-fatal events, measurement of quality of life, and generalizability.
The current and proposed prospective UK cohorts have sufficient power potentially to determine the importance of many traditional and newer CHD risk factors on cardiovascular risk in men, women and even ethnic minorities. However, secure financial support and hence sustainability will remain essential to maximize long-term benefits.
前瞻性队列研究对我们理解英国冠心病（CHD）流行病学做出了巨大贡献。然而，队列的识别以及关键特征和结果的传播可能是随意的，并且很难识别处于规划阶段的研究。
我们通过检索MEDLINE和相关网站并咨询关键人物，对队列研究进行了系统评价。我们纳入了所有主要关注健康受试者中冠心病发展情况的大型英国前瞻性队列研究。
MEDLINE检索到1558条记录，我们确定了39个符合纳入标准的队列。“早期”队列在确定冠心病的主要危险因素方面很重要，尤其是吸烟、胆固醇、血压、身体活动和体重指数。随后，前瞻性队列研究评估了包括营养状况、遗传决定因素、止血因素、血脂亚组分、心理社会因素和“生命历程”观点等潜在重要的新危险因素。心理社会因素相对被忽视，女性、少数族裔和老年人也是如此。关键的方法学问题包括尽量减少失访、标准化测量、质量保证体系、危险因素随时间的变化、残余混杂、回归稀释偏倚、非致命事件的检测、生活质量的测量以及可推广性。
目前和拟议的英国前瞻性队列有足够潜力确定许多传统和新的冠心病危险因素对男性、女性甚至少数族裔心血管风险的重要性。然而，可靠的财政支持以及由此带来的可持续性对于实现长期效益最大化仍然至关重要。
